Neonatal Updates

Lipstein EA, Dodds CM, Britto MT. Real Life Clinic Visits Do Not Match the Ideals of Shared Decision Making. The Journal of pediatrics. 2014. The investigators video-taped discussion of higher risk interventions for chronic conditions (juvenile rheumatoid arthritis and inflammatory bowel disease). The ideals of shared decision making were rarely explicitly achieved.

 Detailed information was typically given about the provider’s preferred option with less information about other options. There was minimal elicitation of preferences, treatment goals, or prior knowledge. Few parents or patients spontaneously stated their preferences or concerns. An implicit or explicit treatment recommendation was given in nearly all visits, although rarely requested. In approximately one-third of the visits, the treatment decision was never made explicit, yet steps were taken to implement the provider’s preferred treatment

There certainly were several limitations in the way the interactions took place, the preferences of the families were never explored, and there was almost no real evaluation of the family’s understanding. We are maybe fortunate, when we are taking life and death decisions about newborn babies, that we are usually able to make time to explore the desires and values of parents. I like to think that the decision which is taken is truly a shared decision, where we work together to find the best option for the particular situation; but I don’t know if a video-tape analysis would always give me high scores!

Schneider LA, Burns NR, Giles LC, Higgins RD, Nettelbeck TJ, Ridding MC, et al. Cognitive Abilities in Preterm and Term-Born Adolescents. The Journal of Pediatrics. 2014. In addition to neuropsych testing these adolescents had transcranial stimulation to measure the excitability of their brains. There were only minor differences between preterm and term born adolescents. ‘Corticomotor excitability explained a higher proportion of the variance in cognitive outcome than GA. But the strongest predictors of cognitive outcome were combinations of prenatal and postnatal factors, particularly degree of social disadvantage at the time of birth, birthweight percentile, and height at assessment.’

Saleemi MS, El-Khuffash A, Franklin O, Corcoran JD. Serial changes in myocardial function in preterm infants over a four week period: the effect of gestational age at birth. Early Hum Dev. 2014.

Eriksen BH, Nestaas E, Hole T, Liestol K, Stoylen A, Fugelseth D. Myocardial function in term and preterm infants. Influence of heart size, gestational age and postnatal maturation. Early Hum Dev. 2014. Two very nice studies with repeated measures on echo of myocardial function that show the effects of maturation and postnatal age.

Di Tommaso M, Seravalli V, Martini I, La Torre P, Dani C. Blood gas values in clamped and unclamped umbilical cord at birth. Early Hum Dev. 2014. Going towards delayed cord clamping raises a number of questions, such as what to do about cord blood gases? This study suggests that gases taken from unclamped cords are very similar to measures taken after clamping, but they didn’t have many that were very abnormal, the results all being within a narrow range.

Broom M, Ying L, Wright A, Stewart A, Abdel-Latif ME, Shadbolt B, et al. CeasIng Cpap At standarD criteriA (CICADA): impact on weight gain, time to full feeds and caffeine use. Archives of Disease in Childhood – Fetal and Neonatal Edition. 2014. You may remember this randomized controlled trial comparing ways of stopping CPAP, just stopping it compared to stopping and restarting again at intervals that get longer. This secondary analysis of some data from the trial shows that the babies tolerated their feeds equally in the 3 groups in the trial, had similar weight gain, and the babies who were in the immediate stopping group came off their caffeine earlier.

About Keith Barrington

I am a neonatologist and clinical researcher at Sainte Justine University Health Center in Montréal
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